ObamaCare turns five: Time to grow up, Affordable Care Act

Despite all the controversy that has surrounded it from the very beginning, the Affordable Care Act turned 5 years old this week. But like any 5-year-old, it still needs someone to hold its hand when it crosses the street. And there are many dangerous, pothole-filled roads lying ahead.

Now that everyone can buy an affordable health care plan, we have to ensure that everyone can see a doctor. Coverage alone is not a proxy for getting care.

The first and most important, of course, is the impending Supreme Court decision on King v. Burwell. If the justices rule that states are not required to accept federal subsidies for residents who join the federal exchange, the whole house of cards could come tumbling down. If people can’t afford to get the care they need, then providing coverage for everyone becomes meaningless.

Now that everyone can buy an affordable health care plan, we have to ensure that everyone can see a doctor. Coverage alone is not a proxy for getting care.

But even if the Court rules that the law should stand, ObamaCare must clear many more hurdles before it can be deemed a success.

The most critical of these is data sharing. The Affordable Care Act calls for simple and transparent sharing of all records within America’s health care system, but right now that’s a pipe dream. Different hospitals use different data systems, and the electronic medical record (EMR) vendors who provide their software – big names like Epic, Cerner and Allscripts – tend to be very territorial. We currently have innumerable islands of data scattered across employers, insurers, doctors, exchanges and healthcare.gov – including patient data, exchange data, enrollment data, claims data, doctor visits and pharmacy costs – and we have no bridge to connect them.

But for ObamaCare to succeed … for affordable care to be available to everyone … for people to be held accountable for efficiency and affordability … the health care system has to be transparent, and all the data have to come together seamlessly. If the EMR vendors don’t want to share and there’s no technology that can integrate the data from their systems to other systems, the data will remain trapped so that no one can use it. Right now, we’re walking into a theater and looking at snippets of trailers instead of the entire movie. We just can’t know the full story until we see it in one place and in one piece.

Another reason we need to implement data sharing is ObamaCare’s call for doctors to be paid on the basis of good outcomes and efficiency. Democrats and Republicans are both making proposals to do that, but without data transparency, it’s just another pipe dream. How can you judge overall performance if you don’t have credible and concise data on which to base your decisions? Essentially, our legislators are trying to create a framework for payment based on a nonexistent foundation.

Data sharing has a direct impact on financial accountability, but the Affordable Care Act doesn’t spell out the true cost of integrating all the data in our health care system. The plan wasn’t made clear … the numbers weren’t accounted for. It’s an incomplete story – like buying a build-it-yourself piece of furniture with only a picture of the finished product, without the required parts to build it and an incomplete instruction manual.

Finally, now that everyone can buy an affordable health care plan, we have to ensure that everyone can see a doctor. Coverage alone is not a proxy for getting care. According to a study published Monday by the American Diabetes Association, “in the states that expanded Medicaid under the ACA, an increased number of Medicaid patients with diabetes are being diagnosed and treated earlier. This could be anticipated to lead to better long-term outcomes.”

That will be a great thing — provided there are enough doctors to treat all the newly diagnosed diabetics. But what happens if we don’t have an adequate supply of doctors in the system? Until we ensure that supply meets demand, we could face much longer wait times to see a physician — if we can find one at all.

Solutions

So … Now what? How do we ensure that ObamaCare is growing nicely when Birthday No. 6 comes around next year? The solution is to legislate a complement to the Affordable Care Act, one we’ll call the Accountable Care Act. This law would require:

• Republicans and Democrats to come together to pass a health information technology integration plan whose architects will be private industry experts who know what it will take to build it.

• Once they’ve completed their blueprint, Congress must budget to build an infrastructure that can sustain it.

• Regardless of what the Supreme Court decides, there needs to be a credible mechanism for funding and sustaining citizens who currently have health insurance coverage, one that doesn’t leave the states in the position of becoming insolvent because the plan wasn’t thought through.

• Funding must be provided to support the training of health professionals over the next 10 years in order to ensure that the supply of doctors meets the demand as an increasing number of people seek care.

Providing affordable medical care to every American is a noble idea. If we can ensure affordability and accountability, it could actually happen.

Dr. Sreedhar Potarazu is an acclaimed ophthalmologist and entrepreneur who has been recognized as an international visionary in the business of medicine and health information technology. He is the founder of VitalSpring Technologies Inc., a privately held enterprise software company focused on providing employers with applications to empower them to become more sophisticated purchasers of health care. Dr. Potarazu is the founder and chairman of WellZone, a social platform for driving consumer engagement in health.